Surgical case

15 December, 2017

Aggressive Surgery Is Best Treatment Option for Early-Stage Lung Cancer

CHICAGO -- November 30, 2017 -- Patients with early-stage lung cancer live longer when they receive a lobectomy rather than a less extensive operation or radiation treatment, according to a study published online today in The Annals of Thoracic Surgery.

“Our data suggest that the more aggressively we treat early lung cancer, the better the outcome,” said lead author Alex Bryant, University of California at San Diego, San Diego, California. “This study is one of the best-powered and detailed analyses to date and suggests that lobectomy is still the preferred treatment of this disease for most patients.”

Using the Veterans Affairs Informatics and Computing Infrastructure (VINCI), Bryant, James D. Murphy, MD, University of California at San Diego, and colleagues identified patients who were diagnosed with early-stage non-small-cell lung cancer (NSCLC) between 2006 and 2015, and who were treated with either surgery or radiation. In all, 4,069 patients were included: 73% (2,986) underwent lobectomy, 16% (634) received a sublobar resection, and 11% (449) received stereotactic body radiation therapy (SBRT).

The researchers described VINCI as an “extremely rich source of health information” from which they were able to gather detailed data related to a large, nationwide group of veterans. The database includes patient-specific data related to preoperative pulmonary function, smoking history, and tumour staging.

Results showed that the 5-year incidence of cancer death was lowest in the lobectomy group at 23%, with the sublobar group at 32%, and SBRT patients at 45%. SBRT also was associated with a 45% increased risk of cancer death compared with lobectomy.

Both surgical groups had higher immediate mortality compared with radiation due to operative risks. The 30-day mortality was 1.9% for lobectomy, 1.7% for sublobar resection, and 0.5% for SBRT.

However, as time went on and with longer follow-up, the surgery groups demonstrated superiority to SBRT, with long-term survival favouring surgery, especially lobectomy, over radiation. The 5-year overall survival rate for the lobectomy group was 70%, followed by the sublobar resection group at 56%, and SBRT at 44%.

“Our data suggest that the higher operative risks of surgery are more than offset by improved survival in the months and years after treatment, particularly for lobectomy,” said Dr. Bryant.